Provider Demographics
NPI:1154328334
Name:THOMPSON, KRISTI M (PT)
Entity Type:Individual
Prefix:
First Name:KRISTI
Middle Name:M
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 949
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30162-0949
Mailing Address - Country:US
Mailing Address - Phone:706-236-2774
Mailing Address - Fax:706-236-2783
Practice Address - Street 1:1579 W CHERRY ST
Practice Address - Street 2:
Practice Address - City:JESUP
Practice Address - State:GA
Practice Address - Zip Code:31545-0611
Practice Address - Country:US
Practice Address - Phone:912-427-2162
Practice Address - Fax:912-427-2562
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2014-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT008273225100000X
FLPT21677225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00342394OtherRR MEDICARE
GA65BBDJBMedicare PIN
FLP00342394OtherRR MEDICARE